Permit a yn
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00658
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
TIGARD Parcel: 1S134 DB04400
Jurisdiction: Tigard
Site address: 11065 SW 109TH AVE
Project: VANDERZANDEN Subdivision: CARNAHANS ADDITION Lot: 6
Project Description: (1) branch circuit for hot tub.
Contractor: GARNER ELECTRIC Owner: VANDERZANDEN, MATTHEW L &
2920 SE BROOKWOOD AVE A CHIE T
HILLSBORO, OR 97123 11065 SW 109TH AVE
TIGARD, OR 97223
PHONE: 503 - 648 -4552 PHONE:
FAX: 503 - 642 -7925
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 11/19/2010 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/19/2010 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952-001-010. 1 o to copy ofthe rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By� Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM :GARNER ELECTRIC FAX Intcrnet: www,tigard-or.gov cli: 5036427925 Nov. 19 2010 07: 42AM P2 .._____
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' City of Tigard , \ \ u , ih R, n1 834 1 . ti 1 0
•'•''• 13125 SW Hall 131vd., Tigard, OR 97223 \\\Z'
i ,AG. ,,ie. „____ . ____. .._ . ..
Other Permit
; p : I ' Phone: 503,639.4171 Pax: 503,598.1960
Inspection i Snel 503.639417,5 _, (* " 0 )'' ' tV5 ' •
Data Re s-y -y iorin. FA ee -
S Page 2 tor
1 R , ,, It 1 P . CS‘ AC$ Notified/Method; _ _17 Suppfementolinformniton
% ,,. .._ ....
?:31, r a.,' ...: .,,. ,.." ,,. ; v ,..,-i,!„. ::F ' : 4 ‘.; ;.;',;;■' ‘ ; •: , 'l . .'1 , *1!: .777.77r.r7.7r7.
E] New construction Id Addition/alteration/replacement mama chcolt all that spply (submit Z sets of plans w/items char=ked - 1.;Tow)
C Service or feeder 400 WW1 or more 0 Building over three stolitts.
0 Demolition 0 Other: where the available Inuit turront 0 Marinas and boatyards
''' 1:17 21111 ),1 ; 6'''i::' ::;1,0:::.t.!q?;!:.1f;,i,,',. exceeds 10,000 PropF al 150 V0115 or 0 Fltattioahttildirtil
less ta grOwnd, OT OXCCC4F 14,000 0 Commercial-use agricultural
• a I- and 2-family dwelling ED Commercial/industrial 0 Accessory building an for In other 'ruminations, buildings.
0 tvlulti-farnily 1713 Mastes builder 0 Other 0 rin pump. 0 Instailinion of "7 KVA or
, , ,, ..1 0 rimergenry system
nibili`WrieetiVirkitif0 A ;!01:y/p A ,i. • o
osi larger seperntely den ve sysiiuu
'" ''''''Lr'-'6,,': i ,'',, -' 1,''' ' ' ,.. '. ' ' — 7 71:■;, • ' „,,,•,: • , • 4,, ' 1•• , i':■ '•, ''. '•: ' k 0 Addition oinew motor ll f r.) "A", "E", "1
Job no.: Job site address: 1 1 0 6 5- , t.09,k in0FIP or mnre.
ED six or more retlifilhilitti 1111itS fivellpifICy,
Cll Recreational yelorte plIrkh,
City/State/Z1P: . 0 ,.. o f OX Ai .Z.,13 0 Noah-care Mollifies. 0 Supply voltage for Mu!
— 0 HBVIODUR 10C1:111011:4, 600 volts nomiutd.
Suite/bIdg,/apt. no.: 1 Project name; 1:1S6TV108 or f1:41481' 600 amps Or more,
77
.f /IP! I;107,77,7.71:-
Cross street/dir ffe
ections to job site: Driptisn k4" .-'--....., I
cqyjilee. 1 Teo . - 1 -• _
— New residential single- or multHarnily dwelling unit.
Includes attached garage.
. _
Subdivision: Lot no.: _1,000 sq. ft or less 14
-_, 4 .
,
— Va. adel 500 sq, fl. or po 3340 1
Tax map/paroel no,; -- .imited energy, residential
ilitgElik,,Vii, s'Ailik ."..:(0eik!■1:•..i, ,: .,,,,,,,., , ./ (with above ag, It) . 75.00 2 —
..,.
Limner energy, multi-family 75,00 2
l C,Ifr 1/(L_Ir),3:1,6 residential (with ribiive sq. ft.) SerVicep or feeders installation, alteration, and/o relocatio”
.., r
• 201 a t 400 amps 200 amps or leas 80,30
ANKIFigetVr.o.,,c, .: ... iskte ,::,.,:, ,, 1 , ; 1:4 : ,,,; / ,A,. ; ,:.:,,:0..;. , 0. ,,.:;nci,of'..... rtgs •
'i `ItglaNal■tu - :•::'' • :_, ,..:_,....,....,,:, '':''' • '::'''' '2 ,...0,..,:,:::3 106.85
., ., 2
401 amps to 600 amps 160.60 2
Name: it ...eL Vara/ .
e z.. r I ' .. ... „ -- , ..„__ _.
/ - ..„. -- 601 amps to 1,000 amps 240.60 2
Address 5 4,5 "9_,,o 6. _.,_ Over 1,000 amps or volts 454.65
Temporary services or feeders nstallation, alteration, niiii71
_ 7 .
City/State/ZIP: . — reloCation
— — ,... ,
Phone: ( ) Fax (
. ) - — 200 amps or less , _ ..
66,85 Fr:
_...._.. ..._
201 amps to 400 aims
Owner installatiodtThis installation is being made on property that 1 own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133,75 2
_
iltrand circuits - new alteration, or Wens:inn, psEnnel
Owner signature: Date: A. FOG for branch circuits with •
i*':;,:‘: :!i;; ;.:1;''' above service or feeder fee, 6.65 2
each branch circuit
BuSiness narrle: 6a/71(7lf C . &Fee tbr branch circuits
—
—..--., . —.
without service or feeder fee,
-
Contact name: . i . ; 5 40 ei_...17 5t- hrital f -- first branch circuit 1 4fi .R5 y 4 2 •
„
Each addl branch circuit 6.65 ,
.,.
Addross: Zqz 5E ii-xl tov 0, 0 ' _. . _ A ilc—ee: .—. . MIscallaneousXecrvice or feeder noti neluded) • -
-, g
City/State/ZIP: " bega 0 9 '?! ----:— Each mantifhetured or modular .
9 ,
.. ._. — — dwelling, service and/or feeder 90.90
Phone -, : (t ) 6 lig, Pax: : (53) 6 q_z.2'z. ,5
-9 _ Reconnect only 66.85
0_
E ' .• ' i s .! ( 0 . 4 , " s , ' ' 0 AM . pump of it circle — 53,40 • 2
4r ii.4!5,AVY .:l..:P".''" 3 75 4 7 ' V i ;.','.,00 Sign or outline lighting 53,40 2
!, '■• ■7,:,-',..;:,;1'; i .,:.; ,,
Signal cirouit(s) or limited-
Busine9S name: , GAR isfig_f C energy panel, alteration, or
_
extension. Describe: Page 2 ,
Address: ZCIV) A.. S, fa:Ci/W1, VA :- ,
, ..„ .
City/State/ZR: l lsbc a y-C) do :, ,.. 97? 1 2... Each additional inspection nvor allow hie In any of the ullo 't
,. .. .. 1 Per inspection _ ...... . i.. 62,50 . _.. _... _.
Phone: t"03 ) 0 5.:,4155.2,_ Fax: ( crl) ( 2_,-)2
1,5 Invest hoa
igation per r (1 hr min) 62.51)
_ , --
CCB Lic.: a I 5 1 Electrical Lie.: ,
,,ek dtjam s v. 1 -) 0 - 7 _5_ , . 1ndustrial plant per bour 73.75
IfitiatM; , j , 14 , ,ctgisAl..., y,ItMIT` pu:s .. _ . ....,
Suprv. Electrician signature, required: Air ' • , , • Subtotal: ,i 56 1 ..,'.
. __.„. ,, .,_. ... -
_______
, .'9 ?Mir •:"."s7 an review (25% of permit fee):
6 224(
Pnnt name'
..C.tlida, -
. • , -.
. .,.. .. .. ____ ---- State surcharge (12% of permit fec): ,5:-•:"c C. - 7 4 1
" - ._... .
—
Authorized signature: TOTAL, PERMIT FEE: ip;
. , . -- This permit application exfdre. if a pernail is not TA, nrd WI ildr '
Print name: Date: days SIMIT it MO been neeepted n• corriflete.
„- .. _... --- " Number of inspections allowed per permit